____________________________________ Plaintiff on behalf of minor child[ren]: ____________________________________ ____________________________________ vs. Case No. _______________ Div. No. ________________ ____________________________________ Defendant PERSONAL AND SERVICE DATA SHEET The purpose of this sheet is to provide the Sheriff’s Department with the necessary information to effect service on Defendant and to provide essential information for the safety of the Sheriff’s Deputy. Information about Defendant is voluntary on the part of the Plaintiff, except physical description and information. In addition, this page establishes a contact number for returning keys to the residence, reentering the house, or obtaining custody of any children involved. This page is for the Court and Sheriff’s use only and will not be part of the packet served to Defendant. PRINT CLEARLY. PLAINTIFF’S INFORMATION (YOU) Plaintiff’s Name: ________________________________________________________ Plaintiff’s Address: ______________________________________________________ _____________________________________________________________________ Phone Number where Plaintiff can be contacted: ______________________________ Does Defendant have keys to your current residence? ______________________ If you have moved, do you want your new address kept confidential so Defendant cannot obtain this information?_____________________________________________ Physical Description of PLAINTIFF (You): Race: _____________ Sex: _______ Age: ______ Date of Birth: ______________ Height: _________ Weight: ________ Hair: ________________ Eyes: __________ 1 American LegalNet, Inc. www.USCourtForms.com DEFENDANT’S INFORMATION Defendant’s Name:______________________________________________________ Other name(s) Defendant may go by/be known as:______________________________ _____________________________________________________________________ Defendant’s Social Security Number (if known):________________________________ Name of Defendant’s Employer: ____________________________________________ Defendant’s Work Hours: _________________________________________________ Does Defendant Operate a Business from his/her Home? ______________ Physical Description of Defendant: (Please attach current photo if available) Race: _____________ Sex: _______ Age: ______ Date of Birth: ______________ Height: _________ Weight: ________ Hair Color/Length: _____________________ Eye Color: __________ Glasses?_______ _ Other Identifying Characteristics (i.e. scars, tattoos, etc.) ____________________________________________________ Description of Defendant’s Vehicle: _________________________________________ Places Defendant is likely to be found:_______________________________________ Has Defendant been arrested? ____________ If so, why? ____________________________________________________________ _____________________________________________________________________ Does Defendant own any weapons? ____________ If so, what kinds? _______________________________________________________ ______________________________________________________________________ Does Defendant have a history of drug or alcohol abuse? _____________ If so, please explain: _____________________________________________________ ______________________________________________________________________ Does Defendant have a history of domestic violence? ____________ If so, please explain: _____________________________________________________ ______________________________________________________________________ Does Defendant have a history of mental illness? ___________ If so, please explain: _____________________________________________________ ______________________________________________________________________ 2 American LegalNet, Inc. www.USCourtForms.com The defendant can be found at: (give all available addresses) HOME: Street __________________________________________________________ City ________________________ State ______________ Zip Code __________ Phone number ____________________________________________________ Times when defendant is usually there _________________________________ WORK: Street __________________________________________________________ City ________________________ State ______________ Zip Code __________ Phone number ____________________________________________________ Times when defendant is usually there _________________________________ OTHER: Please explain ____________________________________________________ Street ___________________________________________________________ City ________________________ State ______________ Zip Code _________ Phone number ____________________________________________________ Times when defendant is usually there _________________________________ 3 American LegalNet, Inc. www.USCourtForms.com IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS _____________________________ Plaintiff on behalf of minor child[ren]: _____________________________ _____________________________ vs. Case No. _____________ Div. No. ______________ _____________________________ Defendant PETITION FOR PROTECTION FROM STALKING ORDER (Pursuant to L. 2002, Ch. 141, § 1 et seq.) 1. I _____________________ live in the City of __________________, in the County of __________________, Kansas. 2. I am seeking protection for: (check all that apply) _____ myself _____ my minor child[ren] (under age 18) _____ a minor child[ren] who lives with me 3. These minor children are involved in this matter:(give full names, ages, and relationship to them)____________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 4. The defendant’s name is _________________________________. 5. I am seeking a protection from stalking order because the defendant has: (Briefly describe the facts about why you are seeking a protection from stalking order):____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4 American LegalNet, Inc. www.USCourtForms.com 6. The defendant’s conduct has caused me to feel: _________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 7. The acts complained of occurred on these dates: _________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ in the county of _______________, Kansas. WHEREFORE, plaintiff requests that the Court issue an order of protection restraining defendant from: _____ a) following, harassing, telephoning, contacting or otherwise communicating with ______________________________ _____ b) abusing, molesting or interfering with the privacy rights of ______________________________________________ _____ c) entering upon or in _____________________ residence or the immediate vicinity thereof. _____ d) other:_________________________________________ ______________________________________________ ______________________________________________ Plaintiff further requests that copies of orders be given to the appropriate law enforcement agencies; that a date, time and place for a hearing on this matter be set; and that summons be issued to defendant, notifying the defendant of this action and the relief requested. Plaintiff further requests that upon hearing of this cause, the Court issue a final order of protection from stalking, enjoining defendant from any acts of stalking against the plaintiff and/or the minor child[ren], and that the Court award to plaintiff the following additional relief: _____ a) attorney's fees, if represented by counsel; and costs _____ b) other, please specify:_____________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ and for such other and further relief, all as appropriate and as the Court deems necessary. ________________________________ Plaintiff’s signature 5 American LegalNet, Inc. www.USCourtForms.com (If attorney represents the plaintiff, the attorney's address and phone number must be provided.) Name:___________________________ Address:_________________________ ________________________________ Phone:(_____)____________________ VERIFICATION STATE OF KANSAS ) ) COUNTY OF DOUGLAS ) ss: _____________________________, of lawful age, being first duly sworn states that (she)(he) is the plaintiff in the above action; that (she)(he) has read the foregoing Petition and knows the contents of it and that the declarations in it are true and correct to the best of plaintiff's knowledge and belief. ________________________________ Plaintiff’s signature Signed and Sworn to (or affirmed) before me on this __________ day of ____________________, 20____________. _____________________________________ Deputy Clerk of the District Court/Notary Public (Pursuant to K.S.A. 53-504) My Appointment Expires:_________________ 6 American LegalNet, Inc. www.USCourtForms.com COMPLETE IF SERVING DEFENDANT AT PLACE OF EMPLOYMENT IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS ______________________________ Plaintiff on behalf of Minor child[ren]: ______________________________ ______________________________ Vs. Case No. _________ Div. No. ___________ ______________________________ Defendant AFFIDAVIT AND REQUEST FOR SERVICE AT PLACE OF EMPLOYMENT STATE OF KANSAS ) ) ss: COUNTY OF DOUGLAS ) I, ____________________________________________, Plaintiff, having been duly sworn on oath, state as follows: I request that the defendant be served at his place of employment because: [Please check one] _____ the defendant is a non-resident who is employed in the State. _____ the defendant’s place of residence is unknown. Please serve the defendant by personal service only at: Name of employer:________________________________________________ Address of employer:_______________________________________________ ________________________________________________________________ _____________________________ Plaintiff’s signature Subscribed and sworn to before me this _______ day of ___________________,20____ __________________________________ Deputy Clerk of District Court/Notary Public My Appointment Expires: _____________ 7 American LegalNet, Inc. www.USCourtForms.com